Episode 131

Understanding and Preventing Elder Abuse

In this important episode, host Lisa Skinner explores a deeply concerning issue that affects millions of older adults worldwide — elder abuse. With compassion and clarity, Lisa explains the many forms this abuse can take, how to recognize the warning signs, and what steps can be taken to prevent or report it.

Every person, regardless of age, deserves to live free from harm, neglect, and exploitation. Yet, according to the Centers for Disease Control and Prevention, approximately one in ten people over age 60 experience some form of abuse each year. This episode sheds light on the silent suffering many elders face — and provides listeners with the tools to recognize, respond, and advocate for those who may be at risk.

Listeners will learn:

  • The different forms of elder abuse — physical, emotional, financial, sexual, neglect, and self-neglect.
  • Who is most at risk, including individuals living with dementia, those dependent on caregivers, and socially isolated adults.
  • The warning signs that may indicate abuse is occurring.
  • Barriers to reporting and why so many cases go unreported.
  • Practical steps to take if you suspect elder abuse — from ensuring immediate safety to reporting and seeking support.
  • Prevention strategies to protect loved ones, including caregiver support, open communication, financial safeguards, and community connection.

Lisa also debunks common myths surrounding elder abuse and discusses the legal and ethical considerations for mandated reporters and caregivers. This episode serves as both an educational guide and a compassionate call to action — reminding listeners that vigilance, empathy, and awareness can make all the difference in keeping our elders safe.

Resources Mentioned:

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.


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Transcript
Lisa Skinner:

Welcome back, everybody. Today, we're going to

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be diving into a somewhat sensitive topic, but a necessary

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one to be aware of. It's the topic of elder abuse, and I'm

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going to cover many aspects of it, including what constitutes

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elder abuse, how to spot warning signs, how to report

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mistreatment, and much, much more. Why? Because every person,

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no matter how old, deserves to be safe from harm by those who

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live with them care for them, or have daily contact with them.

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Yet, approximately one in 10 people, age 60 and older who

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live at home experience abuse, including mistreatment and

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exploitation, and this is according to the Centers for

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Disease Control and Prevention over time, elder abuse can harm

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an individual's physical and psychological health. It can

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destroy social and family ties and cause devastating financial

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loss. Research also suggests that older people who have been

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abused tend to die earlier than those who have not been abused,

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even in the absence of having chronic conditions or life

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threatening diseases. And that's according to The JAMA Network

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article 184, 342, 342, so what does elder abuse actually look

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like? Well, there's no single pattern of elder abuse. It's a

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complex problem that can stem from multiple causes, such as a

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history of violent interactions within the family, lifestyle

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adjustments and tensions that can arise as a result of new

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living arrangements or a caregiver's personal problems,

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for example, caregiver stress, mental or emotional illness,

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addiction to alcohol or other drugs, job loss, or other

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personal crises can lead to the abuse of an older person. Then

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there are certain societal attitudes that may also

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contribute to violence against older people and make it easier

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for abuse to continue without detection or intervention. For

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example, older people are often regarded as being insignificant,

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leading society to fail to recognize the importance of

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assuring dignified, supportive and non abusive life

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circumstances for every older person. These factors include

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the devaluation of and lack of respect for older adults, and

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society's belief that what goes on in the home is a private

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quote, unquote family matter. Who is most affected by Elder

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Abuse, like other forms of abuse, elder abuse, again, is a

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complex problem, and it's easy for people to have

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misconceptions about it. The truth is that most elder abuse

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and neglect does take place in the home. The majority of older

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adults live in the community, either on their own or with

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their spouses, children, siblings or other relatives,

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rather than living in institutional settings. And as a

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result of these statistics, the home is obviously where most

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abuse happens. Family members commit elder abuse in nearly six

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out of 10 cases. That's startling, according to the

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National Council on Aging, anyone can be vulnerable. Older

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individuals who are frail, who are alone or depressed, as well

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as those with a physical disability or mental illness,

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are vulnerable to abuse. However, even those who are not

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affected by these visible risks, can find themselves in abusive

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situations and relationships. Elder abuse affects people

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across all socioeconomic groups, cultures, races and ethnicities.

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Elder Abuse takes many forms. Forms in many different ways.

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Sometimes the signs of abuse are silent or hard to detect, giving

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the perception that everything is okay. So here are some of the

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warning signs that a person may be experiencing abuse, there's

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physical abuse, and it involves including, but not limited to

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inflicting physical pain or injury or inappropriate use of

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restraint, unexplained injuries such as bruises, sprains, burns

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burns and or welts, especially if you're noticing that these

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things are recurring, then there's emotional and

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psychological abuse, and this includes, but not limited to

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insults, threats, humiliating the elder, isolating the elder,

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or intimidating the elder, you'll see sudden or frequent

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withdrawal from social activities. They're scared, or

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they exhibit anxiety around a specific person. They become

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more depressed, or you see sudden extreme mood changes or

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deterioration in their moods or sleep patterns. Also look for

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changes in appetite self blame or expressions of helplessness,

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there's neglect, and what falls into this category are failing

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to provide food, shelter, medicine, hygiene or medical

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care. Those are just a few examples isolation that includes

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limiting the elder from contact with friends and family or

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monitoring their communications. Then, of course, there's

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financial abuse. This can range from theft, misuse of an older

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adult's funds, exploitation of their assets, forging their

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signature, sudden changes in a banking institution. Bills are

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go unpaid, yet funds are disappearing, or new, unfamiliar

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accounts also unexplained changes to wills or a power of

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attorney or a beneficiary signature you notice large

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withdrawals, cash advances or purchases that are not aligned

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with needs or preferences, insistence that the elder's

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finances be managed by the caregiver and or missing

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valuable or inconsistent receipts from shopping or

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services provided there's sexual abuse. This includes

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inappropriate touching, photographing the elder in

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suggestive poses, forcing the elder to look at pornography or

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any unwanted sexualized behavior, as well as non

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consensual sexual contact or coercion by another person. Self

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neglect is also abuse when an older adult is unable to care

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for themselves, they can endanger their own health and

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safety, potentially due to cognitive impairment, depression

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or physical Disability, abandonment falls into the abuse

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category, like deserting, desertion of an older adult by

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someone responsible for their care. So how do we recognize

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elder abuse? Well, recognition can be extremely challenging,

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especially when the abuse is hidden or the elder is reluctant

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to report it. So here are some ideas. Look for a pattern of

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concerning signs across multiple domains. So here's one

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classification, social and environmental signs to look for

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isolation from friends or other family members, conflicting or

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implausible explanations about injuries or their needs, unsafe

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living conditions that includes no heat, unsafe housing or.

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Threats of eviction,

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untreated medical or dental needs, caregiver, elder

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interactions. This look might look like the caregiver refuses

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to leave the elder alone, or the elder is fearful of the

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caregiver. The elder consistently defers to the

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caregiver or avoids questions about their care, apparent

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caregiver stress and blaming the elder for their problems. Again,

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self neglect indicators you might notice, poor hygiene, poor

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personal hygiene. They're always in soiled clothing, and they're

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living in dirty living spaces, their inability to obtain or

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manage food or their medications or even essential services and

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severe, untreated medical conditions due to intentional

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neglect, and some of the other indicators would be poor

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hygiene, malnutrition and dehydration, or you notice that

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all of a sudden, their dentures are missing, their eyeglasses

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have disappeared, their hearing aids cannot be found, or some of

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their other personal belongings. Now I just want to say that some

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signs may actually have a medical explanation or result

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from the fact that they live with cognitive impairment or

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dementia, so keep that in mind before maybe jumping to a rushed

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decision about what's going on, Who is at the highest risk. So

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the list of elders who are at the highest risk of abuse

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include Older Adults with Cognitive Impairment and or

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dementia, dependence on others for daily needs, physically or

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financially, living with a caregiver who is under stress

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has a history of abuse, or they lack training, social isolation

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or lack of supportive networks, a previous history of abuse

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within their own family and financial dependence on their

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caregiver. What are the barriers to reporting and disclosing

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abuse? Well, the most obvious one would be fear of retaliation

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or losing essential caregiver support, losing their

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independence, having cognitive impairment or communication

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difficulties could hinder their memory and ability to

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communicate with others, feeling shame, guilt, embarrassment or a

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believing that abuse is a normal part of living, or it's a

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cultural belief dependency on the abuser for care, and you

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always have to factor in family dynamics or fear of

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institutionalization. What do you do if you suspect elder

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abuse? Step one, the first thing you want to do, make sure the

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elder is safe. If there is any immediate danger or acute harm

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you want to contact emergency services in the US. Dial 911,

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elsewhere, use the local emergency numbers. Number two,

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document what you are observing, record dates, times and

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descriptions of your concerns, note physical signs, statements

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from the elder or changes that you've noticed in their

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behavior, and preserve any physical evidence. So in other

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words, don't wash or move injured belongings unless

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necessary to prevent harm. Step three, try talking with the

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elder, if safe and appropriate, choose a private, calm setting,

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use respectful, non judgmental language. Express concern for

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them and ask open ended questions. For example, I'm

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worried about your safety. Can you tell me what's been

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happening? Avoid pressuring or arguing with them, and respect

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their autonomy and decisions, and then, of course, report it

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what you discover to the right authorities. Reports are often

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confidential and protected by law in the US, you can report to

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adult protective services in your state, your local police or

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sheriff department, a long term care ombudsman if abuse occurs

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in a facility, a state agency overseeing elder care or social

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services, and then in other countries, you can contact a

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social services or Department of Aging and Elder Affairs police

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for criminal abuse, national helplines or elder abuse

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hotlines. If you're uncertain, start with Adult Protective

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Services or local social services, and they can guide you

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seeking additional support medical evaluation for injuries

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or health care concerns by a medical provider or social

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services are available for counseling, respite care and or

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caregiver support. Legal Advice is available. Elder Care

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attorneys on guardianship powers of attorney and or protective

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orders, and then financial protection resources that

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include credit monitoring and fraud protection. And then

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finally, create a safety plan identify trusted individuals who

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can help with daily oversight, arrange for safer housing,

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access to transportation and regular check ins, and then

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consider temporary or permanent changes in caregiving

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arrangements, if you feel that is necessary. Now I'm going to

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talk a little bit about how different settings affect

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reporting and resources, because that varies. So if the abuse is

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occurring and we it's in a home based environment, this often

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requires coordination with adult protective services, social

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workers and primary care providers if the abuse is

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occurring in a nursing home, assisted living memory care

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facility or long term care facility, you want to file

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complaints with state regulatory agencies, the facilities,

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ombuds, person Long Term Care regulators and notice patterns

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of neglect or abuse if the abuse is occurring in a hospital

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setting, the medical teams can document injuries, coordinate

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with social work involvement and report concerns to adult

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protective services if abuse is suspected. So here are some

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prevention strategies for you to be aware of, regular open

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communication with older adults and caregivers. Provide

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caregiver support that includes respite services, training in

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caregiving techniques and in stress management, safeguard

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their finances, monitor their accounts, set up alert

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notifications and Use trusted financial professionals do some

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proactive legal planning

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by creating advanced directives or durable power of attorney

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guardianship arrangements and living wills and trusts ensure

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safe living environment by Monitoring home safety

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assessments and assistive devices to prevent falls. Then

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there are community connections, social groups, senior centers

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and routine check ins. Welfare checks is one of them. And of

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course, always stay on top of educating yourself. Of recognize

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signs of abuse, how to report and how to access the resources

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available in your area or community. Legal and ethical

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considerations to be aware of. Elder abuse is a crime in many

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jurisdictions, the legal definitions, however and

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penalties do vary. There are mandated reporters, many

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professionals, your doctors, your nurses, your social

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workers, teachers, law enforcement, these people are

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legally required to report suspected abuse. It's mandatory

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now, privacy versus safety, balancing elder autonomy with

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protective interventions. Adult Protective Services focus on the

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elders, safety while respecting their rights, capacity and

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consent determine their decision making capacity. Are they

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confused? Are they being coerced? Because all these

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things can definitely and obviously complicate them giving

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consent to anything. So I want to finish by debunking some

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common myths to elder abuse. So the myth, this is one myth, that

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Elder abuse is only about physical harm, the reality it

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comes in a lot of different shapes and forms, including

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emotional, financial neglect, self neglect, among others,

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another myth. Well, the elder will just tell someone if

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something's wrong, the reality of that is that many elders,

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again, their number one fear is retaliation. They feel ashamed

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sometimes, or depend on the abuser for care, making

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disclosures rare. That's the sad truth of this, another myth, if

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there are injuries, it must be due to an accident. But the

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reality to that myth is inconsistent injuries repeated

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incidents, or injuries not matching the elder's activity

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level can certainly indicate abuse. One more myth, reporting

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abuse will ruin the family. Reality, protective services

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prioritize safety and can provide supportive services.

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Reporting can prevent further harm. So hopefully you will

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benefit from being aware of everything that I've shared with

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you today, and this recording, of course, is available for you

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to access when it airs and then anytime in the future. So that

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concludes today's episode of the truth lies in Alzheimer's show.

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And once again, I'm Lisa Skinner, your host, and I

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certainly appreciate you taking the time to spend part of your

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day with us here, and I look forward to bringing you another

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brand new episode next week. Have a great rest of your week,

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and please try to stay happy and healthy. Bye for now.

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About the Podcast

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Truth, Lies & Alzheimer's

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About your host

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Lisa Skinner, CDP, CDT

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.
Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Skinner’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle they can have a better-quality relationship with their loved ones through education and offering workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.